Vascular Update

Vascular Disease in the Metabolic Syndrome: Do We Need to Target the Microcirculation to Treat Large Vessel Disease?
Andrew J. Krentz, Geraldine Clough, Christopher D. Byrne

Institute of Developmental Sciences, School of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK

Address of Corresponding Author

J Vasc Res 2009;46:515-526 (DOI: 10.1159/000226220)

  Key Words

• Metabolic syndrome
• Microvasculature
• Atherosclerosis
• Diabetes mellitus
• Impaired glucose tolerance

  Abstract

The metabolic syndrome of vascular risk is threatening large numbers of ever-younger people. To date, the syndrome has been chiefly viewed as a potential risk marker that confers a heightened probability of developing type 2 diabetes and occlusive atherothrombotic disease of large- and medium-sized arteries. Accumulating evidence suggests that the components of the metabolic syndrome may also adversely affect the microvasculature through several inter-related mechanisms. These include the following observations: classic risk factors for macrovascular disease such as high blood pressure and dyslipidaemia also accelerate microvascular complications of diabetes, lesser disturbances of glucose metabolism (i.e. impaired glucose tolerance) may be associated with some forms of microvascular dysfunction, non-glucose intermediary metabolites may promote renovascular hypertension thereby damaging the microvasculature, and insulin resistance appears to be directly associated with microvascular dysfunction. In turn, microvascular complications such as nephropathy and autonomic neuropathy may promote the development and progression of atherosclerosis. We argue that the vascular implications of the metabolic syndrome should be broadened to include the microvasculature. The hypothesis that vascular events can be prevented, or at least deferred, through earlier therapeutic intervention in pre-diabetic subjects with glucose intolerance is amenable to testing in clinical trials.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Prof. Geraldine Clough
The Institute of Developmental Sciences (IDS Building)
University of Southampton, MP 887, Southampton General Hospital
Tremona Rd, Southampton SO16 6YD (UK)
Tel. +44 23 8079 4292, Fax +44 23 8079 5255/5256, E-Mail G.F.Clough@soton.ac.uk

  Article Information

A.J.K. and C.D.B. have received research funding from pharmaceutical companies involved with cardiovascular and diabetes therapy.

Received: December 19, 2008
Accepted after revision: April 5, 2009
Published online: June 30, 2009
Number of Print Pages : 12
Number of Figures : 1, Number of Tables : 2, Number of References : 145